Efficacy of Low Dose Levobupivacaine (0.1%) for Axillary Plexus Block Using Multiple Nerve Stimulation (Report‪)‬

The axillary brachial plexus nerve block is frequently used for surgical procedures performed on the hand, forearm and elbow. Since Baranowski and Pither (1) introduced the multiple-nerve stimulation technique in 1990, several clinical studies of axillary blockade have reported improved results when comparing multiple to single injections. The multiple-nerve stimulation technique, in which the four main nerves of the plexus are localised at the axilla by a nerve stimulator and separately injected, was shown to produce a high success rate (2-4). Koscielniak-Nielsen et al (5) were the first to report high effectiveness of low-dose axillary block using the multiple-nerve stimulation technique. Serradell et al (6) also obtained similar results in their study. Continuous interscalene nerve block with levobupivacaine 0.125% has been demonstrated to be effective for postoperative analgesia (7). However, no studies have been conducted to determine the efficacy of a lower concentration of levobupivacaine for axillary block. The aim of this prospective, randomised, double-blind study was to determine whether a low concentration of levobupivacaine (0.1%) could be used for axillary block for surgical procedures on the upper limb. We also compared different volumes of low concentration (9 ml x 4 or 18 ml x 4) of levobupivacaine 0.1% with levobupivacaine 0.25% (9 ml x 4) for upper limb surgery.